SELECT DISTINCT e.Emp_Last AS Last_Name ,e.Emp_First AS First_Name ,e.Emp_ID, a.Agency_Name,a.Agency_Address1,a.Agency_City,a.Agency_State,a.Agency_ZIP,a.Agency_Contact_Phone,a.Agent_FEIN, a.Natl_Provider_ID, p.Pt_Agy_ID AS Agency_Assigned_ID, p.Pt_Agy_ID AS HI_Claim_Number, an.F25 AS Admission_Status, p.Pt_Last AS Last_Name_M0040, p.Patient_ID,p.Pt_First AS First_Name_M0040, p.Pt_Middle AS Middle_Initial_M0040, p.Pt_Street AS Street_Address ,p.Pt_Gender AS Gender_M0069, p.Pt_City AS City, p.Pt_State AS State_M0050, p.Pt_Zip AS Zip_M0060, p.Pt_DOB AS DOB_M0066,"" AS MSA_Code, "" AS FIPS_Code, p.Pt_Agy_ID AS Agency_Assigned_ID,"" AS Lives_With_M0340, p.Pt_Race AS Race_M0140_NA, p.Pt_Phone AS Telephone,an.F26 AS Assessment_Reason_M0100,si.Visit_Date, an.F177 AS Certification_start,an.F179 AS Start_of_Care_M0030,an.F178 AS Certification_End, '' AS Source_of_Admission, an.F300 AS HIPPS ,"" AS Claim_Key, "" AS Information_Release, "" AS Admission_Description ,"" AS Homebound_Status ,"" AS HHRG_175_Score, "" AS HHRG_230_Score,"" AS HHRG_250_Score ,"" AS HHRG_390_Score, "" AS HHRG_420_Score, "" AS HHRG_440_Score,"" AS HHRG_450_Score ,an.F176 AS Assessment_Completed_M0090,an.Assmt_ID , pr.Pay_Name As PayName, i.Invoice_ID, i.InvoiceTotal, i.PayerBalance,i.Assmt_ID ,i.errors,i.TOB,i.Internal_control_number, i.claim_status,i.Error_description, i.patient_id,pr.Pay_ID AS Payer_ID, pr.Submitter_ID, pr.Receiver_ID, pr.Pay_Name, pr.Payer_No AS Payer_Number, pr.Pay_Street AS PayAdd1,"" AS PayAdd2, pr.Pay_City AS PayCity, pr.Pay_State AS PayState, pr.Pay_State AS PayZip , 0 AS TurboClaim FROM #Request.prefix_db_agency#.Invoices i JOIN #Request.prefix_db_agency#.pSchedules si ON i.patient_id = si.patient_id JOIN #Request.prefix_db_agency#.pAssessments an ON i.Assmt_ID = an.Assmt_ID JOIN #Request.prefix_db_agency#.pPatients p ON p.patient_id = i.patient_id JOIN #Request.prefix_db_agency#.pPayer pr ON pr.pay_id = i.patientpayer_id JOIN #Request.prefix_db_lookup#.Agency a ON a.Agency_ID = i.Agency_ID JOIN #Request.prefix_db_lookup#.pEmployee e ON e.Emp_ID = si.Emp_ID WHERE i.invoice_id = '#url.inv#' AND i.Agency_ID = '#Session.AgencyId#' AND i.Deleted <> 1 AND pr.Status = '0' AND i.InvoiceTotal > 0 AND p.status < 2 AND si.Status = 0 AND an.Status = 0 GROUP BY i.invoice_id SELECT DISTINCT si.Patient_ID,si.Assmt_ID,i.PatientPayer_ID, count(s.Supply_Sched_ID) as total, si.Skill AS Visit_Type,si.Visit_Date,si.Total_Units, si.Total_Eclaim ,si.Schedule_ID, i.Invoice_ID, i.InvoiceTotal, i.PayerBalance,s.Supply_Sched_ID, sp.Supply, s.Revenue_Code as supply_Revcode, sp.HCPCS as Supply_HCPCS, s.Total_Units as Supply_Units, s.Visit_Date as supply_Visit_Date, s.Payer_ID, s.Total_Price, rc.Rev_CodeID, rc.Visit_Type, rc.Description, rc.Rev_Code, rc.HCPCS, rc.Payer_ID,rc.Status, rc.EClaim_Price, rc.Measure FROM #Request.prefix_db_agency#.Invoices i JOIN #Request.prefix_db_agency#.pSchedules si on si.invoice_id = i.invoice_id LEFT OUTER JOIN #Request.prefix_db_agency#.Supply_Sched s on s.Schedule_ID = si.Schedule_ID LEFT OUTER JOIN #Request.prefix_db_agency#.Supply sp on s.Supply_ID = sp.Supply_ID RIGHT OUTER JOIN #Request.prefix_db_agency#.pRevenue_Code rc on rc.Rev_CodeID = si.Rev_ID WHERE i.invoice_id = '#url.inv#' AND i.Agency_ID = '#session.agencyid#' AND si.invoice_id = i.invoice_id AND si.Assmt_ID = i.Assmt_ID AND si.status = 0 GROUP BY si.Schedule_ID order by si.Visit_Date select Emp_Last AS Last_Name,Emp_First AS First_Name from #Request.prefix_db_lookup#.pEmployee where Emp_ID = '#GetF.Emp_ID#'

#GetF.Agency_Name# 3a PAT.CNTL NO #Agency_Assigned_ID# 4 TYPE OF BILL #Agency_Address1# b. MED.REC NO #Agency_Assigned_ID# #Agency_City# 5 FED.TAX NO 6.STATEMENT COVERS PERIOD FROM THROUGH #Agency_State# #Agent_FEIN# #DateFormat(Certification_Start,"yyyy-mm-dd")# #DateFormat(Certification_End,"yyyy-mm-dd")# #Agency_ZIP# 9.PATIENT ADDRESS                 a #Street_Address# #Agency_Contact_Phone# b #City# 8 PATIENT NAME                      a #First_Name_M0040# c #State_M0050# b #Last_Name_M0040# d #Zip_M0060# #Telephone# 10.BIRTH DATE 11.SEX 12.ADMISSION DATE 14.ADMISSION TYPE 15.ADMISSION SRC #DateFormat(DOB_M0066,"yyyy-mm-dd")# #Gender_m0069# #DateFormat(Start_of_care_M0030,"yyyy-mm-dd")# #Assessment_Reason_M0100# #Source_of_Admission#

42 REV.CD. 43 DESCRIPTION 44 HCPCS/RATE/HIPPS CODE 45 SERV.DATE 46 SERV.UNITS 47 TOTAL CHARGES 48 NON COVERD CHARGES #Rev_Code# #Visit_Type# #HCPCS# #DateFormat(Visit_Date,"yyyy-mm-dd")# #Total_Units# #Total_Eclaim#

50 PAYER NAME 51 HEALTH PLAN ID 52 REL.INFO 53 ASG.BEN. 54 PRIOR PAYMENTS 55 EST.AMOUNT DUE 56 NPI 57 OTHER PRE ID #GetF.PayName# #GetF.InvoiceTotal# #GetF.Natl_Provider_ID# 58 INSURED NAME 59 P.REL 60 INSURED'S UNIQUE ID 61 GROUP NAME 62 INSURNCE GROUP N0 63 TREATMENT AUTHORIZATION CODES 64 DOCUMENT CONTROL NUMBER 65 EMPLOYEE NAME #GetF.Last_Name_M0040#,#GetF.First_Name_M0040# 18  self #GetF.HI_Claim_Number# #GetF.Claim_Key#

66 #GetF.HHRG_175_Score# #GetF.HHRG_230_Score# #GetF.HHRG_250_Score# #GetF.HHRG_390_Score# #GetF.HHRG_420_Score# #GetF.HHRG_440_Score#

69 ADMIT DX 70 PATIENT REASON BX 71 PPS CODE 72 ECI

74 PRINCIPAL PROCEDURE a. OTHER PROCEDURE b. OTHER PROCEDURE 75 76 ATTENDING QUAL CODE DATE CODE DATE CODE DATE #GetPh.Last_Name# #GetPh.First_Name# c.OTHER PROCEDURE d.OTHER PROCEDURE e.OTHER PROCEDURE 77 OPERATING QUAL CODE DATE CODE DATE CODE DATE